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NZMJ 1462.Indd ARTICLE Family planning unmet need and access among iTaukei women in New Zealand and Fiji Radilaite Cammock, Peter Herbison, Sarah Lovell, Patricia Priest ABSTRACT AIM: The aim of the study was to identify unmet need and family planning access among indigenous Fijian or iTaukei women living in New Zealand and Fiji. METHOD: A cross-sectional survey was undertaken between 2012–2013 in five major cities in New Zealand: Auckland, Hamilton, Wellington, Christchurch and Dunedin; and in three suburbs in Fiji. Women who did not want any (more) children but were not using any form of contraception were defined as having an unmet need. Access experiences involving cost and health provider interactions were assessed. RESULTS: Unmet need in New Zealand was 26% and similar to the unmet need found in Fiji (25%). Cost and concern over not being seen by a female provider were the most problematic access factors for women. CONCLUSION: There is a need for better monitoring and targeting of family planning services among minority Pacific groups, as the unmet need found in New Zealand was three times the national estimate overall and similar to the rate found in Fiji. Cost remains a problem among women trying to access family planning services. Gendered traditional roles in sexual and reproductive health maybe an area from which more understanding into cultural sensitivities and challenges may be achieved. amily planning is considered an to be in control of when to have or limit the important tool in averting maternal number and timing of children, giving them deaths and ensuring women’s repro- the autonomy and self-preservation that is F 1 ductive needs are met. The need for family needed for the maintenance of good health. planning is supported by data which shows Given the fi nancial challenges associated that an estimated 35% of all maternal deaths with supporting a growing family, being could be avoided if unintended births were able to control family size can contribute to prevented. Specifi cally, the WHO recom- greater fi nancial stability.6,7 mends that no unmet need for family plan- Although access to family planning is ning should exist, meaning that women who considered more problematic in developing do not wish to have any (more) children are countries where resources are low, minority 2 able to access family planning methods. groups in developed countries experience Reasons for non-use of modern contracep- disproportionately lower uptake of family tive methods have been stated to be largely planning services.8,9 Among Pacifi c popu- 3,4 due to access issues. This view argues that lations in New Zealand, this is the case. if family planning methods were made more In New Zealand, high teenage pregnancy accessible then unmet need would decrease. and low use of contraception characterise Access to family planning is considered Pacifi c reproductive behaviour.10,11 Despite a human rights issue.5 Along with health these outcomes, little is known about Pacifi c and wellbeing, lack of access to family women’s family planning unmet need and planning has social and economic ramifi ca- access. High national contraceptive prev- tions. Ensuring family planning accessibility alence estimates of 72.4% do not seem to warrants individuals with the opportunity refl ect the Pacifi c experience.12 Furthermore, NZMJ 22 September 2017, Vol 130 No 1462 ISSN 1175-8716 © NZMA 46 www.nzma.org.nz/journal ARTICLE unmet need in New Zealand is reported to knowledge, attitudes and practice (KAP), be 8.8%, low in comparison to other coun- unmet need and access was carried out in tries in the developed world.12 Fiji and New Zealand to investigate iTaukei Thus, there seems to be a disconnect women’s family planning behaviour. The between the overall patterns of contra- data presented in this paper focuses on ceptive use and unmet need and the the unmet need and access data from the reported experience of Pacifi c populations KAP study. Women who identifi ed as being in New Zealand. The effects of teenage preg- iTaukei and living in the fi ve major cities nancy and lack of contraceptive use found of New Zealand—Auckland, Hamilton, among Pacifi c groups can lead to long-term Wellington, Christchurch and Dunedin, disability as a result of pregnancy and and in three suburbs in Suva—Samabula, labour, and socio-economic deprivation as Valelevu and Cunningham, were invited a result of teenage pregnancy.13,14 Therefore, to participate in the study. Only women lack of access and uptake of family planning 18 years and above were included in the not only has implications on the individual survey. If women were under the age of 18 but on future generations. or did not identify as being iTaukei, ie, they were Indian or another ethnic group, they Most studies in New Zealand of Pacifi c were not included in the survey. women’s reproductive health behaviour highlight the need for more understanding Sample into social and cultural barriers to repro- The sample size goal for the survey was ductive services, as most found cultural 200 women in each country. This number sensitivities and taboos to be barriers to was needed in order to obtain at least 163 access.15,16 Paterson’s study of a group of completed questionnaires (ie, approximately Pacifi c mothers found that due to cultural 80% response rate) in each country which taboos and sensitivities, most women who would allow the study 80% power to detect did not plan their pregnancy were not a statistically signifi cant (p<0.05) difference aware of family planning and did not like of 15% between countries in the proportion discussing the topic.17 of women who have used family planning, Given these fi ndings, little has been done if this proportion was up to 40% in Fiji and 12,18 to try to capture behaviour involved with higher in New Zealand. Multistage cluster reproductive intentions and family planning sampling carried out in Fiji was based on use. Unmet need investigations give us household income and to ensure repre- that link and quantifi es the proportion sentativeness. Given the challenges with of women whose family planning needs generating representative samples among are not being met. Furthermore, although minority groups and hard to reach groups previous studies of reproductive behaviour in New Zealand, snowball sampling tech- highlight the need for more understanding niques were employed in New Zealand to of socio-cultural factors associated with get as many women involved in the study uptake, more research is needed to identify as we could. Women in New Zealand were what these factors entail and how cultural recruited through community networks, barriers might change within the New social media and Pacifi c organisations. Zealand context. Ethics This study investigates the unmet need of Ethical approval was granted by the Fiji a group of Pacifi c women, iTaukei or indig- National Health Research Council and the enous Fijian and the main barriers to health Human Ethics Committee of the University services. The study draws on the experience of Otago. Approval for working in commu- of iTaukei women in Fiji to provide insight nities in the Suva area was also granted by into unmet need and access changes that the Ministry of iTaukei affairs. Participants might occur among iTaukei in New Zealand. were provided with information sheets prior to fi lling in surveys. Questionnaires were Methods self-administered to ensure privacy and confi dentiality. Cultural protocols and sensi- Design setting tivities were observed with data collected by Between 2012 and 2013, a cross-sec- iTaukei researchers. tional survey of women’s family planning NZMJ 22 September 2017, Vol 130 No 1462 ISSN 1175-8716 © NZMA 47 www.nzma.org.nz/journal ARTICLE Survey questionnaire Women were asked to indicate whether To identify unmet need in the samples, the the following access factors were prob- defi nition presented by Bradley et al (2012) lematic when accessing medical advice or was used to inform survey questions.19 treatment: knowing where to go, getting These included women’s family planning money to go, not having a facility nearby, use, pregnancy intentions and fecundity. having to fi nd transport, not wanting to go Demographic, sexual and reproductive alone, concern there may not be a female health surveys in the Pacifi c were also provider, talking to your husband/partner used to inform questions in the survey. To about it. Chi-square tests of statistical signif- ascertain women’s experience with access, icance were used for comparison of unmet women were asked to indicate whether they need and access factors between countries. found particular access factors, eg, cost, travel, spousal communication and health Results provider characteristics, to be problematic. Overall, 352 women fi lled in a survey The survey questionnaire was available in questionnaire. A higher response rate was both the English and Fijian languages. observed in Fiji as 212 women (out of the Analysis 220 approached) or 96% fi lled in a survey, Analysis of the survey data was carried while 140 (out of the 235 approached) or out using Stata 13 statistical software. Data 60% fi lled a questionnaire in New Zealand. from each country was analysed sepa- Overall, 249 (70%) women were either rately to identify unmet need and access married or in a relationship and eligible to and then comparatively between coun- be included in the unmet need analysis. The tries to see if there were any differences mean age of women in New Zealand was in unmet need and access patterns. The 39 while in Fiji the average age of women Bradley et al (2012) defi nition was used was 36 years.
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